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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Accident and Health — General Knowledge | ~68% | - Types of Health Insurance Policies
|
| Topic 2: Nevada Statutes, Rules and Regulations | ~32% | - General State Insurance Regulations
|
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NEW QUESTION # 88
An Outline of Coverage for Medicare Supplement policies must be provided to a prospective insured at which of the following times?
Answer: B
Explanation:
A Medicare Supplement insurer must provide an Outline of Coverage to the applicant at the time the application is presented. The outline is a consumer-disclosure document designed to summarize the policy's principal benefits, premiums, limitations, exclusions, and other important features before the applicant makes a final purchasing decision.
The outline is not the insurance contract itself. The policy contains the full contractual rights and obligations, but the outline allows an applicant to compare Medicare Supplement plans in a clear and standardized format.
It helps the consumer understand how the policy works with Original Medicare and whether it duplicates other existing coverage.
If the issued policy differs from the coverage described in the original outline, the insurer must provide a substitute outline describing the policy actually issued when delivering it. That later document does not change the initial requirement: the first outline is provided at application.
The premium-payment date and claim-submission date occur too late to serve the purpose of pre- sale disclosure. The key examination concept is timing: applicants receive the Outline of Coverage before purchasing the Medicare Supplement policy.
Study Guide references/topics: Medicare Supplement insurance; consumer disclosures; Outline of Coverage; NAC 687B.250 .
NEW QUESTION # 89
Under an Accidental Death and Dismemberment policy, in which of the following circumstances will an autopsy NOT be performed?
Answer: B
Explanation:
The correct answer is B. An AD & D policy may give the insurer the right to conduct an autopsy when death occurs, provided the autopsy is not prohibited by law. The autopsy provision helps the insurer determine whether the cause of death falls within the policy's accidental-death coverage and whether an exclusion applies. A beneficiary's refusal does not necessarily defeat the insurer's contractual right if applicable law permits the examination. The fact that death resulted from illness rather than an accident may affect whether an AD & D benefit is payable, but it does not itself state the legal restriction on performing an autopsy.
Likewise, an accidental cause of death is precisely the type of circumstance in which the insurer may need medical evidence to verify coverage. The insurer's right is not unlimited: it must comply with legal requirements, including restrictions imposed by statute, court order, or other controlling authority. The exam rule is straightforward: the insurer may conduct an autopsy at its own expense unless doing so is prohibited by law. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Accidental Death and Dismemberment; Autopsy Provision.
NEW QUESTION # 90
An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a disability claim on July 31, the insurance company will MOST likely:
Answer: B
Explanation:
The policy remains in force during its contractual grace period after a premium becomes due. For individual accident and health policies, the required grace period generally depends on premium mode: seven days for weekly premiums, ten days for monthly premiums, and 31 days for other premium modes. A claim occurring within the applicable grace period is not automatically denied simply because the premium has not yet been paid. Instead, the insurer may pay the covered claim and deduct the overdue premium from the amount otherwise payable. Therefore, choice B is the best answer. Reinstatement is unnecessary because the policy has not yet lapsed while the grace period is still running. Cancellation and return of all prior premiums would be inconsistent with the purpose of the grace-period provision. The question tests the difference between a late premium during grace and a lapsed policy after grace expires. Once grace expires without payment, coverage can lapse; if coverage later is reinstated, loss coverage may be subject to reinstatement provisions and limitations. Study Guide References/Topics: Policy Provisions, Clauses, and Riders; Grace Period; Disability Income Insurance.
NEW QUESTION # 91
Which of the following is true regarding Medicare Advantage Plans?
Answer: A
Explanation:
Medicare Advantage, also called Medicare Part C, is private-plan coverage approved by Medicare. These plans must provide at least the services covered by Original Medicare, subject to Medicare rules, but they may structure deductibles, copayments, and coinsurance differently. For many enrollees, a plan's benefit design can reduce or eliminate certain cost-sharing amounts that would otherwise apply under Original Medicare.
Medicare Advantage plans also include a yearly maximum out-of-pocket limit for covered Medicare services.
Vision, hearing, and dental benefits may be offered as supplemental benefits by many Medicare Advantage plans, but they are not universally mandated as a standard benefit in every plan. Drug coverage is commonly included, but it is not restricted to generic medications only. Part D formularies can include both generic and brand-name drugs, subject to plan rules and Medicare requirements.
The final option is incorrect because an enrollee does not receive a reduced premium merely by opting out of preventive care. Preventive benefits and plan premiums are governed by Medicare and plan design rules rather than by an individual's decision to decline a preventive program.
Study Guide references/topics: Medicare Part C; Medicare Advantage; deductibles; coinsurance; out-of- pocket limits; Medicare Advantage cost rules .
NEW QUESTION # 92
An application for an individual Disability Income policy may require all of the following information about the proposed insured EXCEPT for:
Answer: A
Explanation:
The correct answer is D. Underwriting for an individual disability income policy focuses on facts that affect the proposed insured's probability of disability, ability to work, existing income protection, and potential for overinsurance. Marital status and occupation may be relevant to financial and occupational underwriting.
Medical history is directly relevant because past and current health conditions can affect eligibility, exclusions, ratings, or benefit limitations. Other disability policies already in force are important because insurers must evaluate the total amount of disability benefits relative to earned income and avoid excessive coverage. The spouse's occupation ordinarily does not determine the proposed insured's disability risk or benefit eligibility and is therefore the least relevant item. Insurers also may request information about income, employer, job duties, hazardous activities, tobacco use, prior claims, and other sources of disability income.
The producer must obtain complete and accurate answers from the applicant, explain questions when necessary, and avoid making assumptions or completing answers without the applicant's direction. Study Guide References/Topics: Completing the Application, Underwriting, and Delivering the Policy; Disability Income Underwriting; Application Information.
NEW QUESTION # 93
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